Provider Demographics
NPI:1003901000
Name:FLYNN, ROSS LYLE (PHD, LPC, LMFT, NCC)
Entity Type:Individual
Prefix:DR
First Name:ROSS
Middle Name:LYLE
Last Name:FLYNN
Suffix:
Gender:M
Credentials:PHD, LPC, LMFT, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 WALNUT BLVD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307-2073
Mailing Address - Country:US
Mailing Address - Phone:586-242-5512
Mailing Address - Fax:
Practice Address - Street 1:71 WALNUT BLVD
Practice Address - Street 2:SUITE 109
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-2073
Practice Address - Country:US
Practice Address - Phone:586-242-5512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401007374101YM0800X
MI4101006255106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health